Comfort on a ward for older people

BACKGROUND: Comfort is often considered to be a central part of nursing, although the value placed on it may have diminished over time. Many views of comfort are expressed in the literature but it still remains a diffuse concept that requires further clarification. Research evidence about older people and comfort is limited, and further work is needed to find out how staff and patients view comfort and how it is achieved in practice. AIMS: This paper reports a study to investigate what comfort means both to older people in hospital and their health care workers. RESEARCH METHODS: Ethnography was the methodology chosen, and data were collected using in-depth interviews with 19 older people and 27 staff members, and 130 hours of participant observation, complemented by additional weekly visits to the study ward. FINDINGS: Three themes were identified: the nature of comfort/discomfort; key determinants of comfort/discomfort; and the underlying factors that influence the achievement of comfort/discomfort. DISCUSSION: In this hospital setting, the focus of nursing on relief of discomfort suggested a tendency to react to problems, rather than proactively to create an environment that facilitated comfort. Staff were aware of ideals of practice but found these difficult to achieve in reality. In this study comfort was not consistently provided, and some ways of working actively promoted discomfort. As comfort is central to nursing and nursing is central to the care of hospitalized older people, it is crucial that practitioners are enabled to fulfil their potential in this area.     

Interprofessional clinical education for occupational therapy and psychology students: a social skills training program for children with autism spectrum disorders

An interprofessional clinical learning experience was developed for pre-licensure occupational therapy (OT) and psychology graduate students. Students worked in interprofessional teams to plan and implement a social skills training program for children with autism spectrum disorders (ASD). The objectives were to provide a hands-on, student-led clinical experience; facilitate interprofessional collaborative learning through leadership partnerships and teach children with ASD to engage in appropriate social skill behaviors. Concurrently, faculty performed qualitative research to explore how the students worked together to provide intervention to the children. Data were collected via interview, direct observation of student planning sessions and student interprofessional interactions, and collection of posts from an online social network site used for session planning. There were six student participants and two faculty participants. Four themes emerged: learning who I am as a professional, learning to appreciate our professional differences, learning to communicate with each other and figuring it out, for the benefit of the kids. This interprofessional clinical learning experience and research helps ensure that students are adequately prepared to represent their profession as part of a diverse interprofessional health care team.     

Interprofessional training in clinical practice on a training ward for healthcare students: a two-year follow-up

This follow-up study describes the former students' lasting impressions of a two-week interprofessional course on a training ward aimed at enhancing the understanding of the roles of other professions and the importance of communication for teamwork and for patient care as well as providing an opportunity for profession-specific training. A questionnaire with both closed and open-ended questions was sent to 633 former students two years after the course and 348 (55%) responded. The course was rated as very good and most of the former students had lasting and positive impressions. Ninety-two percent of respondents encouraged teamwork in their present work and 90% wanted to retain the course. The qualitative analysis of the open-ended questions resulted in five categories describing students' perceptions: professional role development, working in teams, tutoring, patient care and future aspects of the course and real world practice. Our results suggest that interprofessional training during undergraduate education provides lasting impressions that may promote teamwork in students' future occupational life.     

Patient participation on a ward for frail older people

AIMS: The paper reports a study whose aims were to explore the meaning of participation for older people in hospital and their health care workers and ways in which staff can enhance patient participation in their care. BACKGROUND: Participation in care is a concept that is central to nursing practice. However, little is known about patient and staff views of participation and how it takes place in practice. METHODS: Action research was used, and data were collected by means of focus groups and in-depth interviews. Three focus groups and 24 interviews were undertaken with staff, and 19 interviews were undertaken with patients. The main action undertaken with staff aimed at raising their awareness of participation. In addition small changes in practice were introduced, such as the use of a patient biographical booklet. FINDINGS: The findings suggest that participation is a dynamic process that is integral to the work of nurses and carers. The process is enacted through the themes of facilitation, partnership, understanding the person, and emotional work. CONCLUSION: The study demonstrates how nurses can become increasingly aware of the potential for facilitation and creation of opportunities for participation. It is crucial that practitioners working with older people develop a deeper understanding of participation and are also empowered to act in ways that fit with the needs of this specific client group.     

Twenty years on: training for nurses and occupational therapists in the psychological management of children and adolescents, 1968-88

Twenty years ago The Fleming Nuffield Child Psychiatry Unit, under the aegis of the Adult Education Department of the University of Newcastle upon Tyne, began a new post registration course for training registered nurses in the psychological management of children and adolescents. The writer, who participated in the first training scheme is now honorary tutor to the course, gives a practical account of her experience and views.     

Loneliness: a challenge for nurses caring for older people

Loneliness is a complex concept that involves both psychological and social aspects. This article explores loneliness and the impact it can have on older people. It considers the challenges facing nurses and other healthcare professionals in helping older people to deal with loneliness.     

The workforce in health and social care services to older people: developing an education and training strategy

Planning workforce development across the health and social care services for older people presents a formidable challenge. In England, Workforce Development Confederations are responsible for commissioning the education and training of the current and future health and social care workforce. This article reports on an analysis of local issues in planning the workforce for older people's services undertaken in one Confederation. It reports on the perceived priorities for developing the workforce in older peoples services in a policy environment where multiple initiatives were competing for attention. It highlights the key challenges in planning a strategy that embraces numerous service and education providers and offers practical solutions. Although this analysis was in one Confederation, the issues raised have relevance for other Confederations and their education and service partner organisations.     

A review of preservice training in augmentative and alternative communication for speech-language pathologists, special education teachers, and occupational therapists

Speech-language pathologists, special education teachers, and occupational therapists are all likely to encounter individuals with complex communication needs who require augmentative and alternative communication (AAC) in clinical and educational practice. The research on preservice AAC training for these professionals was thus reviewed to investigate the adequacy and effectiveness of current practices. Results indicate that many preservice programs offer minimal AAC training, faculty members have minimal expertise in AAC, and the effectiveness of preservice programs in equipping professionals for entry-level AAC practice is unclear. Speech-language pathologists, special education teachers, and occupational therapists may thus be at risk of graduating with minimal to no exposure to AAC, with little knowledge or skill in AAC service provision, and may be unprepared for entry-level practice. Strengths and limitations of the reviewed research and future research directions are discussed, along with implications for improving preservice training in AAC.     

Learning orthopaedics: Assessing medical students' experiences of interprofessional training in an orthopaedic clinical education ward

Interprofessional training is becoming commonplace in undergraduate medical education. Orthopaedics is considered to be a setting that offers good opportunities for interprofessional training. Curriculum overload is a common problem, which has to be addressed with respect to content. The aim of this study was to assess medical students' experiences of interprofessional care during their orthopaedic training. Over a two-week period, medical, nursing, physiotherapy and occupational therapy students trained together in teams in an orthopaedic ward (Clinical Education Ward, CEW). A questionnaire was distributed to assess the impact of this new curriculum on medical students. A patient-satisfaction questionnaire was also administered to assess patients' satisfaction with the treatment provided by students at the CEW. In general, the medical students were satisfied with the interprofessional course in the CEW. Of the 178 medical students who took the course, 134 (75%) responded to the questionnaire. Total time devoted to orthopaedics was reported to be between 7 – 44% (mean). The total time regarding medical tasks was reported to be between 57 – 71% (mean). Results from the patient-satisfaction questionnaire showed that patients perceived CEW as highly satisfactory. The medical students reported generally satisfactory experiences of interprofessional orthopaedic training in general. In an interprofessional training context, professional supervision and role modeling takes on added importance, and may be regarded as essential ingredients in helping students to learn effectively within an authentic clinical setting.     

Learning orthopaedics: assessing medical students' experiences of interprofessional training in an orthopaedic clinical education ward

Interprofessional training is becoming commonplace in undergraduate medical education. Orthopaedics is considered to be a setting that offers good opportunities for interprofessional training. Curriculum overload is a common problem, which has to be addressed with respect to content. The aim of this study was to assess medical students' experiences of interprofessional care during their orthopaedic training. Over a two-week period, medical, nursing, physiotherapy and occupational therapy students trained together in teams in an orthopaedic ward (Clinical Education Ward, CEW). A questionnaire was distributed to assess the impact of this new curriculum on medical students. A patient-satisfaction questionnaire was also administered to assess patients' satisfaction with the treatment provided by students at the CEW. In general, the medical students were satisfied with the interprofessional course in the CEW. Of the 178 medical students who took the course, 134 (75%) responded to the questionnaire. Total time devoted to orthopaedics was reported to be between 7 - 44% (mean). The total time regarding medical tasks was reported to be between 57 - 71% (mean). Results from the patient-satisfaction questionnaire showed that patients perceived CEW as highly satisfactory. The medical students reported generally satisfactory experiences of interprofessional orthopaedic training in general. In an interprofessional training context, professional supervision and role modeling takes on added importance, and may be regarded as essential ingredients in helping students to learn effectively within an authentic clinical setting.     

Geriatric Care Boot Camp Series: Interprofessional education for a new training paradigm

Interprofessional education of health care professionals caring for older adults is critical to address the unique needs of geriatric patients. An interprofessional education program – the Geriatric Care Boot Camp Series (“Series”) – was designed for health care professionals to fill this education gap. The program consisted of three half-day, intensive boot camps conducted over a one-year period. A total of 112 learners participated; more than half were nurses. Data analysis revealed statistically significant increases following each boot camp in attendees’ reported knowledge about caring for older adults; statistically significant increases in comfort caring for older adults were also seen among participants in two boot camps. Attendees found the interprofessional nature of the program beneficial and said they would attend a similar program again. The Series is easily replicable, appealing to the target audience, and fulfills the need to better educate health care professionals on caring for older adults.     

Dysphagia, medicines and older people: the need for education

Dysphagia is particularly common in elderly patients and may contribute towards difficulties in swallowing solid dose medications. Two recent community surveys have revealed that the problem might be more prevalent in primary care than previously thought. The community nurse is particularly well placed to help identify patients with dysphagia and provide appropriate support and advice.     

Empowerment, skills, and values: a comparative study of nurses and social workers

This article focuses on social workers and nurses who complement each other's work in providing health care services to their patients. The professional literature suggests that understanding the professional differences between social workers and nurses may lead to more collaboration between these groups. This study empirically compares empowerment, skills, and values of social workers (n = 213) and nurses (n = 152). Nurses reported higher scores in all empowerment and value variables. Nurses also claimed to use more therapeutic and communication skills, and social workers reported the use of more social action skills. The differences in empowerment, skills and values between social workers and nurses are discussed in light of their different professional roles and work environments.     

Continuing professional education and the Internet: views of Alberta occupational therapists

BACKGROUND: Occupational therapists have identified barriers to accessing continuing professional education (CPE) in the traditional face-to-face formats. One alternative to traditional, centrally located, face-to-face CPE is course delivery through the Internet. PURPOSE: This study examined Alberta occupational therapists' perceptions of Internet-based CPE. METHOD: A questionnaire was mailed to 800 randomly sampled Alberta occupational therapists (response rate = 35.5%; n = 281). RESULTS: Respondents pursued CPE to increase skills, knowledge and maintain clinical competency. They reported that a face-to-face CPE course was more useful than distance courses. Although almost 90% of respondents had access to computers with an Internet connection at home or at work, and nearly 65% thought that their computer knowledge was sufficient, only 2.9% had previously taken Internet-based CPE. PRACTICE IMPLICATIONS: In order for the Internet to be accepted as a common, useful and alternative delivery tool for CPE in occupational therapy, the perceived barriers such as the lack of personal time, cost, and limited interaction with other learners and instructors will need to be addressed.